Stop the Stigma

Just a Psych Patient? Stigma in the ER

Just a psych patient? - Stigma in the ER

I saw this CBC News story recently about a man who was written off because he was just a psych patient. I wanted to write about it, then promptly forgot about it until suninthespring brought it to my attention.

In April 2018, David Pontone went to the emergency department at Humber River Hospital in Toronto, Canada. He was experiencing severe leg pain. He also happened to have bipolar disorder, which was stable. The ER doc ordered an MRI and also referred him to the on-call psychiatrist. Notes from his chart state the reason for his visit was bipolar, and the psychiatrist wrote that his main symptom was anxiety.

Come on, big boy

When nothing showed up on the MRI, Mr. Pontone was given the boot. The fact that he was in too much pain to walk was apparently not a problem for them. I’m not sure if the video embedded below will play outside of Canada, but it shows Mr. Pontone falling and then part crawling, part dragging himself along the floor towards the exit. A staff member is standing over him the whole time; the story says it’s a nurse, but it would be very unusual for an ER nurse to be in street clothes, so I wonder if perhaps it was a social worker. Regardless, Mr. Pontone is quoted as saying the staff member told him “You’re a big boy! You’re strong! Come on, big boy, stand up!”

A few days later, he was diagnosed with Guillain-Barré Syndrome, an autoimmune disorder in which the immune system attacks the nerves. Serious stuff.

While this happened almost three years ago, it’s only being made public now because it was quite the production for the family to get a copy of the video, due to the hospital’s privacy concerns regarding other people who appear in it. Apparently, the twit standing over him in the video was fired.

All too common

This is gross. Sadly, it’s not surprising, but still gross. It reminds me of an ER encounter I had a couple of years ago. I went in because I’d been having problems breathing, my blood pressure was really high, and I was so dizzy I could barely walk. They decided I was 100% psych. I called them out on their stigma, and the nurse who had triaged me insisted it couldn’t possibly be stigma, because she had a friend with a mental illness. Oh, well that changes everything! That friend needed to ditch this beeyotch pronto.

This isn’t just the odd instance here and there. People with mental illnesses are less likely to have their physical health concerns taken seriously, as care providers blame it all on their mental illness and punt them over to psychiatry. If two people go into ER with identical symptoms consistent with a heart attack, and one has a history of mental illness and the other doesn’t, who do you think is going to the cardiac cath lab and who’s getting a psych consult and perhaps, begrudgingly, an Ativan? If you guessed that the “psych patient” is less likely to be sent for cardiac catheterization because it’s “all in their head“, research would say you’re right.

You’d think health professionals should know enough to not be this stupid, but that’s clearly not the case. It’s a weird blind spot to have, but I think it’s pretty pervasive, even when it’s not malicious. I remember when my partner at the time was in ICU and I was spending a lot of time there, and they were so impressed that I worked in psychiatry because it must be so hard. For all their knowledge dealing with serious physical health stuff, mental illness was totally outside their sphere of familiarity.

What next?

I don’t know what needs to happen to change this kind of thing. I think it could help if there was staff in-service training where patients with different conditions came in and talked about what their journey through ER had been like. That’s probably not going to do anything about the really entrenched stigma, but it might do some good where it’s more of a blind spot issue.

As for dumbasses like the woman shown in the video, perhaps we need to wait for brain transplants to come along. Until then, I hope she stays far, far away from me and anyone else who is “just a psych patient.”

Mental illness: Stop the stigma - graphic of face and megaphone with the words "speak up"

You can find more on mental illness stigma on the Stop the Stigma page.

Book cover: A Brief History of Stigma by Ashley L. Peterson

A Brief History of Stigma is the upcoming new release from Mental Health @ Home Books. It looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.

Visit the book page for tips on how to be an effective advocate.

65 thoughts on “Just a Psych Patient? Stigma in the ER”

  1. Thank you for bringing this to my attention. I had no idea that stigma in the hospitals was so bad, truly alarming. This makes me feel helpless and frustrated, for I can’t imagine how to begin combating such a thing.

  2. To think that they tried to prevent the video from going public, I don’t think the hospital has learned, that’s so upsetting and frustrating, don’t people have a sense of justice?

    1. Yeah, it can’t have been that technically difficult to make sure faces were blurred out, which definitely points to the hospital just being assholes.

  3. There is no sound on the video but yes the video is horrifying! What the hell? Man can’t walk and they are making crawl (CRAWL) out of the hospital? Aye-yi-yi I have no doubt that happens all the time in US hospitals. Well, actually it does – and not because of psych issues but also ‘homeless’ status issues. Actually this happened to me last October – released after 6 days in the hospital and left to get out of the hospital on my own, no wheel chair to the exit and not allowed to wait in the lobby (due to Coivd rules) for a cab I had to call myself – nurse watched as I dragged myself down the hallway hanging on to the grab bars they have along the walls; guard in the lobby watching as I literally crawled out to the street – all heart these people,all heart.

  4. I had a similar incident even as a mental health nurse when I staggered into A&E, unable to breathe. My GP had actually driven me there after they’d medicated me on their ventilator and my breathing hadn’t improved.

    The triage nurse laughed “you’ve taken on your mental health patient’s woes, too much time sitting around doing nothing – any exertion is causing you to become out of breath, cough, cough!”

    I couldn’t breathe well enough to yell at his ignorance.

    “Oops! Your stats (oxygen levels) are a bit low.” My stats were 87% and here in the UK, anything below 93% is classed a low and needs further assessment. “You need to come in.”

    I was in hospital for 8 days! I really should have reported the triage nurse. I would these days!

  5. I want to share that I had a similar but different story about psyche conditions and hospitals. When I went into the hospital to give birth, I temporarily stopped the lithium for the health of the baby. After my daughter was born and I was still in the hospital, I was somewhat confused as my lithium levels were below therapeutic.

    The team of doctors who were taking care of the birthing process had little to no connection to the psyche team and/or my psyche needs. My expectation at the time was that the doctors would be in coordination and would understand that getting me back on therapeutic psyche meds was a necessity not a nice to have for me. It was at least a day or maybe two before the psyche doctor came and visited me and was sure I had my lithium. Or perhaps he did not come at all – can’t remember just now. I was reeling from the birthing experience with no psyche help to mention. I was very confused at the time about why the doctors weren’t coordinating and treating my bipolar illness after the birthing process.

    I believe this gap in my care is because I was also “just a psyche patient” and not in need of simultaneous post-natal care and psychiatric care in a combined timeline that made sense. To the doctors on call, my psyche condition was not reason enough to extend prompt and thorough psychiatric care in that regard. Now I still live in fear of being hospitalized with the doctors failing to treat both whatever is presenting physically with what I know to be true psychologically.

    This is a little backward from the story you just told, but sharing it made sense to me. Hope that’s OK. Doctors have a long way to go to understand the treatment priorities and protocols when someone is presenting physical as well as psychological symptoms or is presenting physically and has a history of psyche illness. Either way there is much room for improvement.

  6. This is the precise reason I denied mental health issues when seeking medical care while I was severely ill. Unfortunately, 10 years earlier when I entered that system it was to request a refill for an antidepressant I had been taking during the month prior – DEPRESSION – flashing like a big neon sign. Rather than being offered medically based solutions for my more generalized symptoms (like hey, iron deficiency anemia causes fatigue!!! Pain causes brain fog!!), PCLS was often the first service to stop in when I was hospitalized. Not GI, not nephro, but psychiatry. This duality made me very apprehensive to seek treatment for worsening mental illness because I was literally afraid for my life; afraid that they’d miss something vital by saying Bipolar was the cause of anything and everything. And, uh, untreated/improperly treated BD tends to lead to a worse prognosis over time so it was a ‘damned if I do, damned if I don’t’ scenario. Diagnostic overshadowing is a HUGE problem. It’s awful.

    1. The meds can make it hard to deny. My province has a provincial pharmanet system, so if I go into emerg, they see all the meds I’ve had filled at any pharmacy. And heaven forbid, if you have not only one psych med but more than one, call security, we’ve got a crazy person up in here!

      1. Indeed it can. A good friend of mine, who also happened to be a doctor, once told me, “Crazy people get sick too!!” She understood the struggle all too well. Some doctors are more cognizant of the need to check themselves than others. I read something not too long ago about the implementation of implicit bias training into medical school/continuing ed curricula and I think that’s a decent place to start, as biases go beyond impacting those of us with DSM labels. They’re also based on race, age, gender, and economic status…but that’s a whole other can of worms that gets me all wound up, so I’ll stop there. 😉

  7. 2019 we had 2 or 3 ER visits in a short time (weekend) because we could not eat, which was making us vomit, nauseous, dizzy, etc. They would treat the current symptoms with IV but wouldn’t help us figure out how to eat. We did need mental health assistance and they didn’t provide/offer it! They offered to lock us up (72-hour hold) or release us with no psych care. We wound up having to stabilize on our own and then go in-patient. So stigma + no resources equals double cluster fuck.

    We learned recently that this gap is possibly being addressed at the hospital near us: they are building ER psych rooms that are not just holding spaces for perceived self-harm threats but actual acute mental health treatment space. Let’s hope so.

    1. Get locked up or get nothing… hmm, now those are stellar options!

      Hopefully the changes at your local hospital will have an impact. Who knows, a more therapeutic environment might be good for staff’s attitudes as well as being good for patients.

  8. Disgusting disconcerting and demoralizing! Three D’s. But, yeah… I do not want to be treated any different because of my diagnosis. Thats something else to be assertive about, if you think you’re being mistreated. But, not everyone is equipped for that and apparently it’s a trend, treating psych patient like that. Effed up!

  9. I had an allegic reaction to sulfa antibiotics written off as an “anxiety attack”. The next time I took the meds because the hospital had convinced me I wasn’t allergic, I had a much worse, horrible reaction. I was pretty pissed about it. I wrote the hospital a complaint letter about it.

  10. Things like this really make you feel helpless. I am lucky enough to never have had a situation where medical people would blame any physical health concerns on my mental illness, and I don’t think I realised the extend of how awful and common this problem is. I really feel for people who have been through this.

  11. This makes me so angry. One of the main reasons I decided to start speaking out about mental health and mental illness was because of the poor treatment, and sometimes outright neglect, that I experienced while moving through our healthcare system. It seems like all of us have an ER horror story to share. Truly heartbreaking.

  12. I don’t know what it is like now, but sime years back, based on what my mum told me over some years, going to the GP about a concern, she felt because she has Paranoia Schizophrenia, she felt she wasn’t taken seriously. Some months, or a year later, after kept going back about her breathing, she learnt she had one and a half lungs.

  13. Yes, this kind of bias exists, just as racial and sexist bias exist, and they all affect us in that way: we are not heard, particularly when one has all three at once.
    How do we help build the empathy and the willingness to pause long enough to evaluate the person standing before us, for all of us?

      1. Hmm, I think/imagine/suspect/desperately hope that building empathy and connnection will help, and maybe some more training in spotting ingrained biases?

  14. When it comes to the social reality of (at least for the foreseeable future) the prevalence of mental illness I’m often left frustrated by the contradictory proclamations and conduct coming from one of the seven pillars of our supposedly enlightened culture—the media, or more specifically that of entertainment and news.

    They’ll state the obvious, that society must open up its collective minds and common dialogue when it comes to far more progressively addressing the real challenge of more fruitfully treating and preventing such illness. After all, its social ramifications exist all around us; indeed, it’s suffered by people of whom we are aware and familiar, and/or even more so to whom so many of us are related to some degree or another.

    Perhaps needless to say, the above-mentioned most commonly occurs when a greatly endeared celebrity passes away or dies an untimely death. This fact was in particular exemplified immediately following the many predictable platitudinous sound bites and mini-memorial commentaries from the late actor/comedian Robin Williams’ contemporaries as well as in many newspaper letters and editorials following his tragic suicide.

    However, that’s when the doublespeak so boldly occurred. The vast majority of the mainstream media, if not in its virtual entirety, distinctly appeared to willfully overlook Williams’ full mental health diagnosis, if not current condition—i.e. bipolar disorder (a.k.a. manic depression).

  15. I haven’t been keeping up with you, only because I’ve been under extreme stress trying to get all my work done according to things such as deadlines and schedules and other elements of the “mainstream” that I don’t manage very well. (Other elements of the mainstream include computer failures, program crashes, and insomnia.)

    But this post intrigues me, because I was about to make create a post or podcast about how, when I was experiencing homelessness, I was given lower priority in the E.R. because I was “just a homeless person.”

    That I was a known homeless person who had been to a certain E.R. enough times to be recognized probably didn’t help. But it was definitely the case that if I went to a hospital where I was unknown, and when I didn’t “look like a homeless person,” I received more equitable treatment.

    This particular stigma probably developed because many homeless people do use the E.R., especially during graveyard shift, as a temporary shelter. The stigmatic preconception is that all homeless people do so.

    A quick Wiki search reveals: “Social stigma is the disapproval of, or discrimination against, a person based on perceivable social characteristics that serve to distinguish them from other members of a society.”

    This stigma spoils the identities of psych patients in emergency rooms, and homeless people in emergency rooms as well. Fascinating stuff.

    1. Substance abuse is another instant black mark. I remember once when I was working in community mental health being so pissed off because I had put in a lot of work to get this totally bonkers dude in front of a doctor to get him committed, and then the ER turfed him later that day saying he was just a drug user. So not okay.

      1. Yes, that’s another one. And of course there is the stigma that homelessness and drug addiction are synonymous. Maybe I’ll write a quick blog post with a personal account on one of my breaks today.

          1. I’d do it right now but I’m putting myself on a 45 minute work / 15 minute break schedule to maximize efficiency, and it just turned 9:30. Check back in one hour.

            1. OK Ashley it’s posted. I posted the conversation to the best of my memory. I’ll edit it later but the information is there. (Gotta get back to work).

  16. You wrote about it! 🙂 I didn’t know that there was actually research that backed up the discrepancy. Wow. I like your idea about having patients talk to the doctors. I think that could be helpful with a lot of things, really. It’s often hard to express yourself coherently when you’re in intense pain or in a crisis (aka when you’re in the ER), and sometimes we only really realize/understand things after the fact.

    Okay now I googled it because I was curious, and yup, there’s a ton of research on it!! https://www.sciencedirect.com/science/article/pii/S2215036614000236

    1. Yeah, it’s pretty clear that it’s not just “psych patients’ misperceiving things; this is really happening, and it’s causing a lot of harm.

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